ELLSWORTH — The question of how much medical care costs rarely has a straightforward answer, even for simpler procedures, so it’s no surprise that coronavirus, with its many presentations, offers up a more complicated picture. But what does it cost to treat a patient hospitalized with coronavirus?
“Treating someone could range anywhere from testing and primary care correspondence and visits through inpatient hospitalization or even in an ICU setting, so there is a wide variety,” said Paul Bolin, senior vice president and chief human resources officer at Northern Light Health.
“Testing for the coronavirus is required to be covered by insurance companies at no cost,” said Joanne Rawlings-Sekunda, director of the Consumer Health Care Division at the Maine Bureau of Insurance, in an email.
“However, there may be other costs associated with a doctor’s officer or clinic visit, depending on the case or course of treatment offered and depending on an individual’s insurance.”
Insurance companies are required to cover the cost of a coronavirus diagnostic test. (Medicare is reimbursing providers between $36 and $51.) But for many people, including the 225 Mainers who have been hospitalized as of May 19, those costs could be much higher.
Asked to provide an estimate for the cost, Maine Department of Health and Human Services spokeswoman Jackie Farwell pointed to several national analyses.
Health Affairs estimated in an article in late April that the median cost to treat a single hospitalized case of COVID-19 would be roughly $14,366. Health-care company Kaiser’s policy arm, Kaiser Family Foundation, came up with a similar figure for less severe hospitalizations ($13,297), rising to $40,218 for patients who need ventilator support for more than 96 hours, both estimates based on Medicare payments to hospitals for patients with respiratory infections.
But Medicare reimbursements to hospitals tend to be far less than what private insurers pay.
The Peterson-Kaiser Family Foundation found that for patients with insurance through large employer plans, ventilator treatment for respiratory conditions ranged from $34,223 to $88,114, “depending on the length of time ventilation is required, for patients in large employer plans.”
“Under the CARES Act,” notes the article, “Medicare will pay a 20 percent premium for COVID-19 treatment, but per admission payment is still less than that for the same type of admission for people with private plans, on average.”
The Trump administration has said it plans to reimburse hospitals for treating uninsured patients (roughly 100,000 Mainers were uninsured in 2018, according to the Census Bureau) using money from a $100 billion fund created by the Coronavirus Aid, Relief and Economic Security (CARES) Act.
That could mean total payments to hospitals for treating uninsured patients of between $13.9 billion and $41.8 billion, depending on how the money is allocated, according to Kaiser. “The legislation provided little detail about how funding would be distributed, giving significant discretion to the Secretary of Health and Human Services.”
So how much of those costs would a patient pay? It depends on how whether you have insurance and what it covers, of course, but the Peterson-Kaiser Family Foundation estimates that patients with private insurance could pay more than $1,300, similar to the out-of-pocket costs for patients hospitalized with pneumonia ($1,464).
“Average out-of-pocket costs for pneumonia admissions are similar regardless of severity,” write the authors, “because many people with hospitalizations reach their deductible and/or out-of-pocket max, thus limiting their exposure to the underlying cost.”